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BACKGROUND: Radiation-induced fecal urgency syndrome is highly prevalent in gynecological cancer survivors. It is associated with decreased quality of life (QoL) and with disability pension. The literature remains unclear about the mediating role of physical and psychological aspects of QoL in the association between urgency syndrome and disability pension. Identifying the pathways between urgency syndrome and disability pension may help to create effective and timely interventions for increasing QoL and reducing disability pension among gynecological cancer survivors. METHODS: We used patient-reported outcome measures from working-age gynecological cancer survivors (n = 247) and data on their disability pension from the official register. The mediating role of physical and psychological aspects of QoL was studied by utilizing mediation analysis based on the counterfactual framework, appropriate for binary outcome, binary mediator with an exposure-mediator interaction. The total effect (TE) was divided into direct and indirect effects using single mediation analysis. Adjusted relative risks and percentage mediated (95% confidence intervals) were calculated. All statistical tests were two-sided. RESULTS: Urgency syndrome increased the risk of disability pension both directly and indirectly (via QoL). Satisfaction with sleep mediated half of the TE (RR = 2.2 (1.1-4.1)) of urgency syndrome on disability pension. Physical health also mediated a similar proportion of the TE (RR = 2.1 (1.2-3.9)). The proportions mediated were higher for physical aspects of QoL (35%-71%) than for psychological aspects (2%-47%). CONCLUSIONS: The investigated aspects of the self-assessed QoL of gynecological cancer survivors may play a role in these women's continuing work-life. It appears that physical health, satisfaction with sleep, psychological well-being, and other investigated aspects of QoL mediate the urgency syndrome-disability pension association.
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Supervivientes de Cáncer , Personas con Discapacidad , Neoplasias , Humanos , Femenino , Calidad de Vida , PensionesRESUMEN
PURPOSE: Gynaecological cancer patients treated with external radiation therapy to the pelvis may face long-lasting and long-term gastrointestinal syndromes. The aim of this study was to assess the association between such radiation-induced survivorship syndromes and disability pension among gynaecological cancer survivors treated with pelvic radiation therapy. METHODS: This prospective register study included gynaecological cancer survivors (n=247) treated during 1991-2003, alive at the time of the study, and <65 years of age. In 2006, they completed a postal questionnaire measuring patient-reported outcomes. The self-reported data were linked to the national register on disability pensions. Relative risks and risk differences with 95% confidence intervals (CIs) of being granted a disability pension were estimated using log-binomial regression. RESULTS: Gynaecological cancer survivors with gastrointestinal syndromes had a higher risk of disability pension than survivors without such syndromes. Survivors with blood discharge syndrome had a 2.0 (95% CI 1.3-3.2) times higher risk of disability pension than survivors without blood discharge syndrome. The relative risk among survivors with urgency syndrome was 1.9 (1.3-2.9) and for leakage syndrome, 2.1 (1.4-3.1). Adjusting for age did not affect our interpretation of the results. CONCLUSIONS: Gynaecological cancer survivors with a specific radiation-induced survivorship syndrome have a higher risk of disability pension than survivors without that specific syndrome. IMPLICATIONS FOR CANCER SURVIVORS: The findings highlight the need for more awareness and knowledge regarding the potential role of radiation-induced survivorship syndromes for continuing work among gynaecological cancer survivors. Work-life-related parameters should be considered during radiotherapy and rehabilitation after treatment.
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Supervivientes de Cáncer , Personas con Discapacidad , Neoplasias , Traumatismos por Radiación , Humanos , Pensiones , Factores de Riesgo , Sobrevivientes , SupervivenciaRESUMEN
Stress can affect work ability. The aim of this study was to identify how this pathway is mediated over time in young adults. Participants of the Work Ability in Young Adults cohort were selected. A theoretical framework was built, which lead to a statistical model. Selected dimensions of mediators were recovery, work demands affecting private life, feelings of control over private life, and physical activity in leisure time. A quadruple serial mediation model was built with four mediators. The total effect of stress on work ability was -0.3955, 95% CI [-0.4764, -0.3146]. The total indirect effect amounted to 81% with an effect of -0.3182, 95% CI [-0.3750, -0.2642]. The relationship between stress and Work Ability Score five years later in young adults was mediated by stress five years later, work demands affecting private life, feelings of control over private life and feeling well-rested upon waking. These results indicate that work demands affecting private life and feelings of control over private life are important mediators of the relationship between stress and work ability in young adults. A well-balanced relationship between work and private life can counteract the influence of stress on work ability in this age group.
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Emociones , Estrés Psicológico , Evaluación de Capacidad de Trabajo , Estudios de Cohortes , Femenino , Humanos , Actividades Recreativas , Masculino , Adulto JovenRESUMEN
PURPOSE: The purpose was to examine long-term consequences of exposure to electrical current passing through the body. We investigated (1) whether electricians after having experienced an electrical accident report more cognitive problems and lower mental wellbeing and (2) have objectively verifiable reduced cognitive function; and (3) which circumstances at the time of the accident affect long-term subjective cognitive function and mental wellbeing? METHODS: A survey of male electricians who had experienced electrical accidents (n = 510) and a clinical study in a subsample (n = 23) who reported residual health problems was carried out. Both groups were examined regarding subjective cognitive function (Euroquest-9) and mental wellbeing (Symptom Checklist-90 subscales). The clinical study included neuropsychological tests of memory, attention, spatial function, and premorbid intellectual capacity. A matched control group was retrieved from reference data. RESULTS: The survey participants reported more cognitive problems and lower mental wellbeing than referents. Of the examined circumstances, having experienced mortal fear at the time of the accident and health complaints, especially mental symptoms, for > 1 week after the accident were the most significant risk factors for later subjective cognitive problems and lower mental wellbeing. The only statistically significant difference in neuropsychological tests was better performance in part of the memory tests by the clinical study group compared to the control group. CONCLUSIONS: The participants reported more cognitive problems and lower mental wellbeing than referents, but no long-term objective cognitive dysfunction was detected. Emotional response at the time of the accident and health complaints in the aftermath of the accident may constitute important indications for medical and psychological follow-ups.
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Accidentes de Trabajo/psicología , Cognición , Traumatismos por Electricidad/psicología , Salud Mental , Adulto , Anciano , Humanos , Masculino , Memoria , Persona de Mediana Edad , Pruebas Neuropsicológicas , Encuestas y Cuestionarios , Suecia , Adulto JovenRESUMEN
This review aimed to identify risk factors for occupational accidents and illnesses among young workers in the Nordic countries and to attain knowledge on specific vulnerable groups within the young working force that may need special attention. We conducted a systematic review from 1994 to 2014 using five online databases. Of the 12,528 retrieved articles, 54 met the review criteria and were quality assessed, in which data were extracted focusing on identifying occupational safety, health risk factors, and vulnerable groups among the young workers. The review shows that mechanical factors such as heavy lifting, psychosocial factors such as low control over work pace, and organizational factors such as safety climate are all associated with increased injury risk for young Nordic workers. Results show that exposures to chemical substances were associated with skin reactions, e.g., hand eczema. Heavy lifting and awkward postures were risk factors for low back pain, and high job demands were risk factors for mental health outcomes. The review identified young unskilled workers including school drop-out workers as particularly vulnerable groups when it comes to occupational accidents. In addition, apprentices and young skilled workers were found to be vulnerable to work-related illnesses. It is essential to avoid stereotyping young Nordic workers into one group using only age as a factor, as young workers are a heterogeneous group and their vulnerabilities to occupational safety and health risks are contextual. Politicians, researchers, and practitioners should account for this complexity in the education, training and organization of work, and workplace health and safety culture.
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The purpose of this study was to carry out a review of observational studies that consider links between mobile phone use and mental health from a psychological or behavioral perspective. Systematic literature searches in PubMed and PsycINFO for articles published until 2017 were done. Exclusion criteria included: papers that considered radiofrequency fields, attention, safety, relational consequences, sexual behavior, cyberbullying, and reviews, qualitative, and case or experimental studies. A total of 4738 papers were screened by title and abstract, 404 were retrieved in full text, and 290 were included. Only 5% had any longitudinal design. Self-reporting was the dominating method of measurement. One third of the studies included children or youth. A majority of adult populations consisted of university students and/or self-selected participants. The main research results included associations between frequent mobile phone use and mental health outcomes, such as depressive symptoms and sleep problems. Mobile phone use at bedtime was associated with, e.g., shorter sleep duration and lower sleep quality. "Problematic use" (dependency) was associated with several negative outcomes. In conclusion, associations between mobile phone use and adverse mental health outcomes are found in studies that take a psychological or behavioral perspective on the exposure. However, more studies of high quality are needed in order to draw valid conclusions about the mechanisms and causal directions of associations.
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Conducta Adictiva/epidemiología , Uso del Teléfono Celular/estadística & datos numéricos , Depresión/epidemiología , Salud Mental , Trastornos del Sueño-Vigilia/epidemiología , Envío de Mensajes de Texto/estadística & datos numéricos , Humanos , Estudios Observacionales como Asunto , Investigación , Trastornos del Sueño-Vigilia/psicologíaRESUMEN
BACKGROUND: It is well known that electrical accidents can cause physical injury. Less well known is that long-term consequences may include emotional and cognitive problems. OBJECTIVE: To explore electricians' experiences and perceptions of work-related electrical accidents, with focus on psychological short- and long-term consequences, including how contacts with health care services and the workplace were perceived. METHODS: Semi-structured interviews with 23 Swedish male electricians, aged 25- 68, who had experienced at least one electrical accident and reported residual sensory, musculoskeletal, cognitive or emotional symptoms. Data was analyzed by means of qualitative content analysis. RESULTS: Immediate emotional reactions included surprise, confusion, fear, anxiety, and anger; also long-term consequences were seen. Experiencing a no-let-go situation was particularly stressful. The cause of the accident, and questions about guilt and blame were central in the aftermath. Lack of knowledge and routine among health care professionals concerning electrical injury was reported, as well as lack of medical and psychological follow-up. CONCLUSIONS: For some informants, the accident had been a life-changing event, while for others it was an event of little importance. Adequate handling at the workplace, and from health care personnel, including follow-up, could facilitate rehabilitation and return to work.
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Accidentes/psicología , Traumatismos por Electricidad/psicología , Acontecimientos que Cambian la Vida , Percepción , Accidentes/estadística & datos numéricos , Adulto , Anciano , Traumatismos por Electricidad/complicaciones , Humanos , Entrevistas como Asunto/métodos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , SueciaRESUMEN
The aim was to examine whether texting on a mobile phone is a risk factor for musculoskeletal disorders in the neck and upper extremities in a population of young adults. In a longitudinal population-based cohort study with Swedish young adults (aged 20-24 years) data were collected via a web-based questionnaire at baseline (n = 7092) and after one and five years. Cross-sectional associations were found between text messaging and reported ongoing symptoms in neck and upper extremities (odds ratios, ORs 1.3-2.0). Among symptom-free at baseline prospective associations were only found between text messaging and new cases of reported symptoms in the hand/fingers (OR 2.0) at one year follow up. Among those with symptoms at baseline prospective associations were found between text messaging and maintained pain in neck/upper back (OR 1.6). The results imply mostly short-term effects, and to a lesser extent, long-term effects on musculoskeletal disorders in neck and upper extremities.
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Teléfono Celular , Dolor Musculoesquelético/epidemiología , Dolor de Cuello/epidemiología , Parestesia/epidemiología , Envío de Mensajes de Texto , Femenino , Humanos , Estudios Longitudinales , Masculino , Dolor Musculoesquelético/etiología , Dolor de Cuello/etiología , Parestesia/etiología , Factores de Riesgo , Encuestas y Cuestionarios , Suecia/epidemiología , Envío de Mensajes de Texto/estadística & datos numéricos , Extremidad Superior , Adulto JovenRESUMEN
Immediate and delayed outcomes after electrical injury. A guide for clinicians In Sweden about 300 electrical injuries are recorded each year at the Swedish National Electrical Safety Board. Most of our knowledge of the health consequences of these arise from clinical case series. Severe electrical injuries have direct thermal effects and may result in ventricular fibrillation, skin burns, as well as muscular and nerve affection. Long-term consequences include pain, vascular symptoms, cognitive and neurological symptoms and signs. These sequelae may occur even though the initial symptoms were relatively modest. Mechanisms are better understood for the immediate symptoms, compared to long-term and delayed non-thermal medical consequences. Attention to and treatment of patients with electrical injury needs to be improved to minimize long-term consequences. Good medical care in the acute phase and early multidisciplinary follow-up of severe cases will likely reduce associated morbidity. Each electrical injury should result in an inquiry to identify the cause of the accident in order to suggest actions to prevent new incidents.
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Traumatismos por Electricidad/complicaciones , Cuidados Posteriores , Traumatismos por Electricidad/epidemiología , Traumatismos por Electricidad/terapia , Tratamiento de Urgencia , Humanos , Anamnesis , Suecia/epidemiología , Factores de TiempoRESUMEN
BACKGROUND: The prevalence of overweight among Swedish young adults has nearly doubled since the 1980s. The weight increase has been paralleled by the increased use of computers at work, at school, and at leisure time. The aim was to examine leisure time computer use for gaming, and for emailing/chatting, in relation to overweight development in young adults. METHODS: A prospective cohort study with Swedish young adults (20-24 years at baseline) who responded to a questionnaire at baseline (n = 6735), and after 1 year (n = 3928) and 5 years (n = 2593). Exposure variables were average daily time spent on leisure time computer gaming and emailing/chatting. Logistic regression was performed for cross-sectional analyses with overweight (BMI ≥ 25) and obesity (BMI ≥ 30) as the outcomes, and for prospective analyses with new cases of overweight at the 1- and 5-year follow-ups. Change in BMI from baseline to 5 year-follow-up was analyzed with linear regression. RESULTS: There were cross-sectional and prospective associations between computer gaming and overweight (BMI ≥ 25) in women, after adjusting for age, occupation, physical activity, sleep, social support, and total computer use. For the men, only cross-sectional associations could be seen. Spending more than 2 h daily for emailing and chatting was related cross-sectionally to overweight in the women. No clear prospective associations were found for emailing/chatting and overweight development in either sex. CONCLUSIONS: We have identified a new risk group for overweight development: young adult female computer gamers. Leisure time computer gaming was a prospective risk factor for overweight in women even after adjusting for demographic and lifestyle factors, but not in men. There were no clear prospective associations between computer use for emailing/chatting and overweight in either sex.
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Actividades Recreativas , Estilo de Vida , Sobrepeso/epidemiología , Juegos de Video/estadística & datos numéricos , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Masculino , Actividad Motora/fisiología , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Instituciones Académicas , Encuestas y Cuestionarios , Suecia/epidemiología , Juegos de Video/psicología , Aumento de Peso , Adulto JovenRESUMEN
BACKGROUND: We have previously studied prospective associations between computer use and mental health symptoms in a selected young adult population. The purpose of this study was to investigate if high computer use is a prospective risk factor for developing mental health symptoms in a population-based sample of young adults. METHODS: The study group was a cohort of young adults (n = 4163), 20-24 years old, who responded to a questionnaire at baseline and 1-year follow-up. Exposure variables included time spent on computer use (CU) in general, email/chat use, computer gaming, CU without breaks, and CU at night causing lost sleep. Mental health outcomes included perceived stress, sleep disturbances, symptoms of depression, and reduced performance due to stress, depressed mood, or tiredness. Prevalence ratios (PRs) were calculated for prospective associations between exposure variables at baseline and mental health outcomes (new cases) at 1-year follow-up for the men and women separately. RESULTS: Both high and medium computer use compared to low computer use at baseline were associated with sleep disturbances in the men at follow-up. High email/chat use was negatively associated with perceived stress, but positively associated with reported sleep disturbances for the men. For the women, high email/chat use was (positively) associated with several mental health outcomes, while medium computer gaming was associated with symptoms of depression, and CU without breaks with most mental health outcomes. CU causing lost sleep was associated with mental health outcomes for both men and women. CONCLUSIONS: Time spent on general computer use was prospectively associated with sleep disturbances and reduced performance for the men. For the women, using the computer without breaks was a risk factor for several mental health outcomes. Some associations were enhanced in interaction with mobile phone use. Using the computer at night and consequently losing sleep was associated with most mental health outcomes for both men and women. Further studies should focus on mechanisms relating information and communication technology (ICT) use to sleep disturbances.
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Computadores/estadística & datos numéricos , Depresión/epidemiología , Internet/estadística & datos numéricos , Trastornos del Sueño-Vigilia/epidemiología , Estrés Psicológico/epidemiología , Estudios de Cohortes , Depresión/etiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Prospectivos , Trastornos del Sueño-Vigilia/etiología , Estrés Psicológico/etiología , Encuestas y Cuestionarios , Suecia/epidemiología , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Because of the quick development and widespread use of mobile phones, and their vast effect on communication and interactions, it is important to study possible negative health effects of mobile phone exposure. The overall aim of this study was to investigate whether there are associations between psychosocial aspects of mobile phone use and mental health symptoms in a prospective cohort of young adults. METHODS: The study group consisted of young adults 20-24 years old (n = 4156), who responded to a questionnaire at baseline and 1-year follow-up. Mobile phone exposure variables included frequency of use, but also more qualitative variables: demands on availability, perceived stressfulness of accessibility, being awakened at night by the mobile phone, and personal overuse of the mobile phone. Mental health outcomes included current stress, sleep disorders, and symptoms of depression. Prevalence ratios (PRs) were calculated for cross-sectional and prospective associations between exposure variables and mental health outcomes for men and women separately. RESULTS: There were cross-sectional associations between high compared to low mobile phone use and stress, sleep disturbances, and symptoms of depression for the men and women. When excluding respondents reporting mental health symptoms at baseline, high mobile phone use was associated with sleep disturbances and symptoms of depression for the men and symptoms of depression for the women at 1-year follow-up. All qualitative variables had cross-sectional associations with mental health outcomes. In prospective analysis, overuse was associated with stress and sleep disturbances for women, and high accessibility stress was associated with stress, sleep disturbances, and symptoms of depression for both men and women. CONCLUSIONS: High frequency of mobile phone use at baseline was a risk factor for mental health outcomes at 1-year follow-up among the young adults. The risk for reporting mental health symptoms at follow-up was greatest among those who had perceived accessibility via mobile phones to be stressful. Public health prevention strategies focusing on attitudes could include information and advice, helping young adults to set limits for their own and others' accessibility.
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Teléfono Celular/estadística & datos numéricos , Depresión/fisiopatología , Trastornos del Sueño-Vigilia/epidemiología , Estrés Psicológico/epidemiología , Estudios de Cohortes , Estudios Transversales , Depresión/etiología , Femenino , Humanos , Masculino , Estudios Prospectivos , Factores de Riesgo , Trastornos del Sueño-Vigilia/etiología , Estrés Psicológico/etiología , Encuestas y Cuestionarios , Suecia/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Prospective associations have been found between high use of information and communication technology (ICT) and reported mental symptoms among young adult university students, but the causal mechanisms are unclear. Our aim was to explore possible explanations for associations between high ICT use and symptoms of depression, sleep disorders, and stress among young adults in order to propose a model of possible pathways to mental health effects that can be tested epidemiologically. METHODS: We conducted a qualitative interview study with 16 women and 16 men (21-28 years), recruited from a cohort of university students on the basis of reporting high computer (n = 28) or mobile phone (n = 20) use at baseline and reporting mental symptoms at the one-year follow-up. Semi-structured interviews were performed, with open-ended questions about possible connections between the use of computers and mobile phones, and stress, depression, and sleep disturbances. The interview data were analyzed with qualitative content analysis and summarized in a model. RESULTS: Central factors appearing to explain high quantitative ICT use were personal dependency, and demands for achievement and availability originating from the domains of work, study, social life, and individual aspirations. Consequences included mental overload, neglect of other activities and personal needs, time pressure, role conflicts, guilt feelings, social isolation, physical symptoms, worry about electromagnetic radiation, and economic problems. Qualitative aspects (destructive communication and information) were also reported, with consequences including vulnerability, misunderstandings, altered values, and feelings of inadequacy. User problems were a source of frustration. Altered ICT use as an effect of mental symptoms was reported, as well as possible positive effects of ICT on mental health. CONCLUSIONS: The concepts and ideas of the young adults with high ICT use and mental symptoms generated a model of possible paths for associations between ICT exposure and mental symptoms. Demands for achievement and availability as well as personal dependency were major causes of high ICT exposure but also direct sources of stress and mental symptoms. The proposed model shows that factors in different domains may have an impact and should be considered in epidemiological and intervention studies.
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Teléfono Celular/estadística & datos numéricos , Comunicación , Computadores/estadística & datos numéricos , Salud Mental , Adulto , Depresión/etiología , Femenino , Estudios de Seguimiento , Humanos , Entrevistas como Asunto , Masculino , Investigación Cualitativa , Trastornos del Sueño-Vigilia/etiología , Estrés Psicológico/etiología , Estudiantes/psicología , Suecia , Universidades , Adulto JovenRESUMEN
OBJECTIVES: This study prospectively assessed the importance of individual conditions and computer use during school or work and leisure time as risk factors for self-reported generally reduced productivity due to musculoskeletal complaints among young adults with musculoskeletal symptoms in the neck or upper extremities. METHODS: A cohort of 2914 young adults (18-25 years, vocational school and college or university students) responded to an internet-based questionnaire concerning musculoskeletal symptoms related to individual conditions and computer use during school or work and leisure time that possibly affected general productivity. Prevalence ratios (PR) were used to assess prospective risk factors for generally reduced productivity. RESULTS: The selected study sample (N=1051) had reported neck or upper-extremity symptoms. At baseline, 280 of them reported reduced productivity. A follow-up of the 771 who reported no reduced productivity was carried out after 1 year. Risk factors for self-reported generally reduced productivity for those followed-up were symptoms in two or three locations or dimensions for the upper back or neck and the shoulders, arms, wrists, or hands [PR 2.30, 95% confidence interval (95% CI) 1.40-3.78], symptoms persisting longer than 90 days in the shoulders, arms, wrists, or hands (PR 2.50, 95% CI 1.12-5.58), current symptoms in the shoulders, arms, wrists, or hands (PR 1.78, 95% CI 1.10-2.90) and computer use 8-14 hours/week during leisure time (PR 2.32, 95% CI 1.20-4.47). A stronger relationship was found if three or four risk factors were present. For women, a relationship was found between generally reduced productivity and widespread and current symptoms in the upper extremities. CONCLUSIONS: The main risk factors for generally reduced productivity due to musculoskeletal symptoms among young adults in this study were chronic symptoms in the upper extremities and widespread symptoms in the neck and upper extremities.